Reference Request Form "*" indicates required fields APPLICANT NAME* First Last JOB TITLE* NAME OF EMPLOYER* START DATE* DD slash MM slash YYYY END DATE* DD slash MM slash YYYY SALARY ON LEAVINGIN WHAT CAPACITY DID YOU KNOW THE CANDIDATE? PLEASE DESCRIBE THE MAIN RESPONSIBILITIES OF THE APPLICANT'S POSITIONDID THE APPLICANT CARRY OUT THESE DUTIES SATISFACTORY? YES NO HAS THERE BEEN ANY DISCIPLINARY OR SAFEGUARDING ISSUES YES NO IF NO PLEASE EXPLAINPERFORMANCE Excellent Good Average Below Average Poor ATTITUDE Excellent Good Average Below Average Poor DEPENDABILITY Excellent Good Average Below Average Poor ATTENDANCE Excellent Good Average Below Average Poor HONESTY Excellent Good Average Below Average Poor PERFORMANCE Excellent Good Average Below Average Poor WOULD YOU RE-EMPLOY THIS PERSON? YES NO IF YES PLEASE EXPLAINFOR WHAT REASON DID THE APPLICANT LEAVE YOUR COMPANY? REFEREE DETAILSNAME* First Last POSITION* COMPANY NAME* TELEPHONE NO*EMAIL*SIGNED* DATE* DD slash MM slash YYYY Δ
